4. Strengthen Yang to elevate “white,” nourish Yin to elevate “platelets,” and tonify Qi and blood to elevate “red.”

<!-- translated-chunk:6/21 -->

The condition is often acute, with most cases presenting as a pattern of intense internal heat and excessive fire that drives blood to flow abnormally. (A very small number of cases involve qi deficiency that fails to control the blood.) In such situations, Professor Pei Zhengxue advocates clearing heat, draining fire, and cooling the blood. He highly appreciates Tang Rongchuan’s view that the heart is the “ruler” of fire, which generates blood; blood is the essence of fire, and fire is the soul of blood. When fire rises, blood rises; when fire descends, blood descends. Understanding that blood is born from fire and that fire resides in the heart, he believes that draining the heart is equivalent to draining fire, and draining fire is equivalent to stopping bleeding. For acute hemorrhage and infection in aplastic anemia, he often chooses Sanhuang Xiexin Tang, considering it the first-choice formula for draining fire and stopping bleeding in such cases. This formula is distinctly bitter and cold, directly attacking excess fire while incorporating hemostasis within the process of fire drainage. Adding 20 grams of Shengdi Huang aims to cool the blood, thereby enhancing its hemostatic effect; adding 30–60 grams of Shengshigao further strengthens the fire-draining power, with the rationale: “Shengshigao has a mild taste and a heavy nature—its mildness enters the qi, while its heaviness reaches the blood. For fevers associated with blood disorders, this herb is indispensable for clearing them.” Through long-term clinical observation, he has developed the principle: “For chronic conditions, tonify the spleen and kidney; for acute conditions, drain fire and cool the blood.”

4. Strengthen Yang to elevate “white,” nourish Yin to elevate “platelets,” and tonify Qi and blood to elevate “red.” In his long clinical practice, Professor Pei Zhengxue proposed the concepts of strengthening Yang to elevate “white,” nourishing Yin to elevate “platelets,” and tonifying Qi and blood to elevate “red.” Although these are merely empirical observations, they embody the essence of clinical practice. The Suwen states: “Yang transforms into qi, while Yin forms substance.” Zhang Jingyue added: “Yang moves and disperses, thus transforming into qi; Yin remains still and condenses, thus forming substance.” From the functional attributes of white blood cells and platelets, white blood cells seem to belong to Yang, platelets to Yin, and red blood cells can be regarded as tangible blood; therefore, methods to elevate them should focus on tonifying Qi and blood.

Below are some commonly used herbs by Professor Pei Zhengxue: To elevate white blood cells, he mainly uses cinnamon, fuzi, kushen, dangshen, buguozhi, jixueteng, huangqi, xiyangshen, and bayajianxiang; to elevate platelets, he mainly uses yuzhu, huangjing, dazao, shengdihuang, ejiao,

gui ban jiao, lu jiao jiao, lianqiao, and tu da huang; to elevate red blood cells, he mainly uses guipi tang, renshenyangrong tang, taizishen, rensen xu, dangshen, huangqi, he shouwu, shanzhuyu, longyan rou, jixueteng, nüzhenzi, and hanlian cao. (4) Case Analysis Case 1: A 42-year-old female patient, first visited on December 28, 2009. Chief complaint: lumbosacral soreness and fatigue for one year. Present illness: At the end of 2008, scattered purpura appeared on both lower limbs; on December 24, 2009, bone marrow aspiration diagnosed her with aplastic anemia. She had previously received hormone and immunosuppressive therapy (cyclophosphamide) at a local hospital, but the effects were poor, so she sought treatment at Professor Pei Zhengxue’s outpatient clinic. Findings: Pale complexion, dizziness and tinnitus, lumbosacral soreness, fatigue, pale-red tongue with thin white coating, and fine, rapid pulse. Blood routine showed: White blood cells 2.3 × 10^9/L, red blood cells 1.55 × 10^12/L, hemoglobin 58 g/L, and platelets 21 × 10^9/L. Western diagnosis: Aplastic anemia. TCM differentiation: Deficiency of vital essence and blood deficiency. Treatment principle: Tonify essence and marrow, and benefit qi to generate blood. Prescription: Ren shen xu 15 g, tai zi shen 15 g, bei sha shen 15 g, dang shen 15 g, dang gui 12 g, chuan xiong 6 g, sheng di huang 12 g, he shouwu 15 g, xianhe cao 15 g, tu da huang 10 g, jixueteng 15 g, hong hua 6 g, mu dan pi 6 g, dan shen 20 g, shan zhu yu 30 g, long yan rou 10 g, si zi 10 g, gou qi zi 10 g, nüzhenzi 10 g, rou cong rong 10 g, ma qian zi 1 piece (fried), one dose per day, decocted in water and taken in two divided doses; deer antler and leeches are packaged in capsules in equal parts, 0.5 g each time, twice daily. After one month of medication, her spirit markedly improved, her complexion returned to normal, and symptoms such as dizziness, palpitations, and lumbosacral soreness completely disappeared. Follow-up blood routine showed: White blood cells 4.34 × 10^9/L, red blood cells 4.36 × 10^12/L, hemoglobin 127 g/L, and platelets 109 × 10^9/L. She was advised to continue taking Pei’s Hematopoietic Granules for maintenance, with the basic composition being: Shengdi Huang, shanyao, shan zhu yu, dan pi, fu ling, ze xie, ren shen xu, tai zi shen, bei sha shen, xiyang shen, lu dang shen, mai dong, wu wei zi, gui zhi, bai shao, sheng jiang, dazao, zhi gan cao, fu xiao mai, 15 g each time, twice daily; deer antler and leeches are packaged in capsules in equal parts, 0.5 g each time, once daily. Pei’s Hematopoietic Granules are primarily based on Liuwei Dihuang Tang, with deer antler added to tonify essence and marrow; ren shen xu, tai zi shen, bei sha shen, and lu dang shen strengthen the spleen and benefit qi; Gui Zhi Tang harmonizes the yin and yang of the internal organs; Shengmai San benefits qi and nourishes yin; Gan Mai Da Zao nourishes the heart and calms the spirit; leeches break up blood stasis. This formula integrates kidney-tonifying, spleen-strengthening, and blood-activating effects in one, with a rigorous formulation and rich content. The patient undergoes follow-up every month, and her condition remains stable. Case 2: Mr. Qiao, a 19-year-old male. He has suffered from aplastic anemia for 14 years and usually receives treatment at the outpatient clinic using a modified version of the Lanzhou Formula, with stable condition. In July 2000, he developed skin purpura due to a cold, accompanied by gingival, nasal, and head symptoms, along with fatigue, pallor, warmth in the hands and feet, thin yellow coating, and rapid pulse. Physical examination: Body temperature 37.8°C, heart rate 112 beats/min, respiration 22 breaths/min, blood pressure 108/86 mmHg, clear consciousness, severe anemic appearance. Blood routine: White blood cells 2.1 × 10^9/L, red blood cells 1.28 × 10^12/L, hemoglobin 40 g/L, platelets 14 × 10^9/L, reticulocyte count 0.12%. Urine routine: Trace blood (++), otherwise normal. Stool routine normal. Biochemical tests: ALT 68 U/L, otherwise normal. Bone marrow smear: Bone marrow hyperplasia is low, especially in the erythroid lineage, with only two megakaryocytes seen across the entire slide. TCM differentiation: Yin deficiency with internal heat, blood not retained, treated with the Lanzhou Formula modified to address both root and branch issues. Prescription: Add tu da huang 15 g, mu tou hui 10 g, nüzhenzi 15 g, hanlian cao 15 g to the Lanzhou Formula to increase platelets, reduce ren shen xu, dang shen, and Gui Zhi Tang, aiming to nourish Yin without fueling Fire, preventing qi-tonifying from exacerbating heat. During severe bleeding, add 15 g of peppermint charcoal, 15 g of cypress charcoal, and 15 g of madder root charcoal, decocted and taken once daily. Intermittent blood and platelet transfusions. After one month of treatment, gum bleeding and nasal bleeding decreased, skin petechiae reduced, but she remained pale, weak, prone to colds, with a pale tongue, thin white coating, and large pulse. Blood transfusion was stopped. Red blood cells 3.2 × 10^12/L, white blood cells 2.4 × 10^9/L, hemoglobin 50 g/L, platelets 81 × 10^9/L, reticulocyte count 0.42%. Prescription: Shengdi 12 g, shan yu rou 20 g, shanyao 10 g, dan pi 10 g, fu ling 12 g, ze xie 10 g, gui zhi 10 g, bai shao 10 g, sheng jiang 6 g, dazao 4 pieces, zhi gan cao 6 g, xiyang shen 15 g, huangqi 30 g, tu da huang 15 g, nüzhenzi 15 g, hanlian cao 15 g, gou qi zi 15 g, xianhe cao 15 g, lianqiao 15 g, ma qian zi 1 piece (fried), dang gui 10 g, fu xiao mai 30 g, mai dong 10 g, wu wei zi 3 g, jixueteng 15 g, deer antler 1.5 g (infused), after three months of medication, her complexion became rosy, her tongue turned pale red, coating became thin and white, and pulse grew deep and fine. Red blood cells 2.4 × 10^12/L, white blood cells 4.6 × 10^9/L, hemoglobin 103 g/L, platelets 90 × 10^9/L, reticulocyte count 0.39%. The above prescription was adjusted by reducing lianqiao, gou qi zi, xianhe cao, deer antler, and tu da huang, while adding fangfeng 12 g, ren shen xu 15 g, long yan rou 30 g, xuan shen 15 g, dang shen 15 g, bai shu 10 g, leeches 3 g (infused), after three months of medication, switched to Pei’s Fuzheng Granules (an in-house preparation of the Lanzhou Formula), continued taking it for one year, with no recurrence during follow-up. In March 2002, the patient was admitted to the emergency room due to “jaundice, fatigue, and tooth problems for two weeks,” with ALT 246 U/L, diagnosed as acute icteric hepatitis. At that time, blood counts showed pancytopenia, reticulocyte count 0.53%, and bone marrow smear indicated active proliferation, but only two megakaryocytes were seen across the entire slide. Professor Pei Zhengxue diagnosed the case as a combination of new disease and existing illness, treating the new disease first, then the existing illness. Differential diagnosis: Deficiency of root and excess of branch, treatment principle: Address both root and branch simultaneously, prescribing Xiao Chai Hu Tang plus Wu Wei Xiaodu Yin. Prescription: Chai hu 10 g, huang qin 10 g, ban xia 6 g, dang shen 10 g, sheng jiang 6 g, gan cao 6 g, dazao 4 pieces, er hua 15 g, lianqiao 15 g, pu gong ying 15 g, bai hua she she cao 15 g, ban zhi lian 15 g, yin chen 15 g, shan zhi zi 10 g, sheng da huang 10 g, dan shen 30 g, huang qi 30 g, nüzhenzi 15 g, hanlian cao 15 g. After ten doses, the jaundice completely subsided, liver function returned to normal, and hemoglobin rose to 100 g/L, reticulocyte count normalized, white blood cells reached 5.6 × 10^9/L, platelets 114 × 10^9/L. Suspecting possible errors, a bone marrow biopsy was performed, which showed: normal bone marrow morphology. Aplastic anemia was clinically cured as a result, so the patient was advised to continue taking the Lanzhou Formula regularly. Follow-up for three years showed stable condition. Note: Diseases caused by congenital defects are prone to hepatitis A infection. Professor Pei Zhengxue believes that in TCM, extreme deficiency corresponds to extreme excess, and aplastic anemia is particularly susceptible to hepatitis. Therefore, the traditional Chinese medicine formula Xiao Chai Hu Tang is the first choice for treating aplastic anemia complicated by various types of hepatitis, often with life-saving effects. In this case, the patient’s condition was critical, but treatment reversed the situation almost immediately, highlighting the importance of clinical attention. Moreover, the traditional Chinese medicine leech has hormone-like effects and proves effective. Erzhi Wan tonifies the kidneys without causing greasiness or harming the spleen, especially suitable for patients with long-term aplastic anemia who have difficulty regulating yin deficiency. It helps maintain “yin balance and yang concealment,” making aplastic anemia treatable. Case 3: Mr. Bai, a 54-year-old male, visited in November 2003. He complained of dizziness, fatigue, loss of appetite, constipation, feeling cold and having cold limbs, and lumbosacral soreness. Physical examination: Thin physique, anemic appearance, heart and lungs ( ), abdomen flat and soft, spleen palpable about 3 cm below the ribs, pale tongue with little coating, and deep, weak pulse. Laboratory tests: Red blood cells 2.1 × 10^12/L, hemoglobin 63 g/L, platelets 50 × 10^9/L, white blood cells 2.0 × 10^9/L, reticulocyte count 1.2%. Western diagnosis: Bone marrow smear confirmed aplastic anemia. Prescription: Treat with qi-tonifying and spleen-strengthening, modifying Guipi Tang. Use dang shen 10 g, bai shu 10 g, huang qi 30 g, dang gui 10 g, fu ling 12 g, gan cao 6 g, mu xiang 3 g, long yan rou 20 g, fuzi 6 g, cinnamon 3 g, jixueteng 15 g, buguozhi 15 g. Decocted once daily. After more than 20 doses, his spirit and appetite improved, bowel movements became regular, but he still felt cold and had lower back pain, along with tinnitus. Tongue and pulse remained unchanged. Lab results: Hemoglobin 82 g/L, platelets 61 × 10^9/L, red blood cells 2. 85 × 10^12/L, white blood cells 2.6 × 10^9/L. Therefore, the prescription was further adjusted to Yougui Wan with added ingredients: shanyao 15 g, deer antler glue 10 g, gou qi zi 15 g, du zhong 10 g, shan zhu yu 30 g, dang gui 10 g, fuzi 6 g, cinnamon 3 g, tu si zi 15 g, sheng di huang 15 g, dan shen 10 g, mu xiang 3 g, cao dou kou 13 g, decocted once daily. After another 30+ doses, symptoms of coldness and lower back pain significantly improved. Follow-up blood routine: Hemoglobin 103 g/L, platelets 64 × 10^9/L, red blood cells 3.4 × 10^12/L, white blood cells 3.4 × 10^9/L, approaching normal levels. Case 4: Ms. Shen, a 19-year-old female, with a three-year history of aplastic anemia, visited in February 2004. Symptoms: Dizziness, fatigue, vertigo and tinnitus, nosebleeds, gum bleeding, dry throat, and heavy menstrual flow. Physical examination: Pale complexion, scattered ecchymoses under the skin of both upper limbs. Heart and lungs unremarkable, abdomen flat and soft, spleen not palpable under the ribs, tongue dark red with little coating, pulse tight and rough. Laboratory tests: White blood cells 2.8 × 10^9/L, red blood cells 1.39 × 10^12/L, hemoglobin 58 g/L, reticulocyte count 1%, platelets 27 × 10^9/L. Western diagnosis: Bone marrow smear confirmed aplastic anemia. TCM differentiation: Kidney-yin deficiency with blood stasis. Treatment principle: Nourish yin and tonify kidney, activate blood circulation and remove stasis. Prescription: Use dang gui 10 g, chuan xiong 6 g, jixueteng 15 g, dan shen 15 g, hong hua 6 g, sheng di huang 12 g, xianhe cao 15 g, he shouwu 15 g, tu da huang 15 g, black soybeans 30 g, shan zhu yu 20 g, long yan rou 15 g, nüzhenzi 15 g, gou qi zi 15 g, buguozhi 15 g, rou cong rong 10 g. After 28 doses of the above prescription, symptoms of dizziness and vertigo eased, but nosebleeds and dry throat persisted. Blood routine showed: hemoglobin 63 g/L, platelets 39 × 10^9/L, red blood cells 2.54 × 10^12/L, white blood cells 4.4 × 10^9/L. Therefore, the above prescription was adjusted by removing buguozhi and adding huang lian 3 g, huang qi 10 g. After another 40+ doses, follow-up blood routine showed: Hemoglobin 85 g/L, platelets 63 × 10^9/L, red blood cells 3.5 × 10^12/L, white blood cells 3.8 × 10^9/L. All symptoms disappeared. Case 5: Mr. Ma, a 54-year-old male. Visited in May 1992. He complained of dizziness, fatigue, loss of appetite, constipation, feeling cold and having cold limbs, and lumbosacral weakness. Physical examination: Thin physique, both lungs unremarkable, abdomen flat and soft, spleen palpable under the ribs, tongue pale with little coating, pulse deep and weak. Lab results: Red blood cells 2.1 × 10^9/L, hemoglobin 63 g/L, platelets 50 × 10^9/L, white blood cells 2.0 × 10^9/L, reticulocyte count 1.2%